ISSN 0103-5150

Fisioter. Mov., Curitiba, v. 28, n. 1, p. 23-30, Jan./Mar. 2015

Licenciado sob uma Licença Creative Commons
DOI: http://dx.doi.org.10.1590/0103-5150.028.001.AO02

[T]

Effect of cryotherapy on the ankle temperature in

athletes: ice pack and cold water immersion

[I]

Efeito da crioterapia na temperatura do tornozelo

de atletas: pacote de gelo e crioimersão

[A]

Vanessa Batista da Costa Santos, Camila dos Santos Cardoso, Camila Pelegrin Figueiredo,
Christiane de Souza Guerino Macedo*

Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil

[R]

Abstract
Introduction: Cryotherapy is often used for rehabilitation of injured athletes. Objective: To compare the ef-
fectiveness of ice pack (IP) and cold water immersion (CWI) on lowering the ankle skin surface temperature
in athletes. Materials and methods: Thirteen athletes (seven women and six men), age 19.53 (± 2.9) years.
IP and CWI were applied on the anterior talofibular ligament (ATFL) of the dominant leg for 30 minutes. The
skin surface temperature was measured with an infrared digital thermometer prior to the application and
during cryotherapy (10, 15, 20, 25 and 30 minutes) and up to two hours of rewarming. During rewarming,
the athletes remained at rest and the temperature was measured every 1 minute until 10 minutes, every 5
minutes for up to an hour and every 15 minutes until 2 hours. Results: The two types of cold application
were effective in lowering the skin surface temperature after the 30-minute procedure. Significant differ-
ences were observed among the following temperatures: pre-application (IP = 29.8 ± 2.4 °C and CWI = 27.5 ±
3 °C – P < 0.05); after 30 minutes (IP = 5 ± 2.4 °C and CWI = 7.8 ± 3 °C – P < 0.01). For rewarming, after 25

* VBCS: MSc, e-mail: vann_costa@hotmail.com

CSC: Grad., e-mail: camilafit@hotmail.com
CPF: Spec., e-mail: milapelegrin@gmail.com
CSGM: PhD, e-mail: chmacedouel@yahoo.com.br

Fisioter Mov. 2015 Jan/Mar;28(1):23-30

 Santos VBC, Cardoso CS, Figueiredo CP, Macedo CSG.
24

minutes (IP = 20.8 ± 3.3 °C and CWI = 18.2 ± 2.7 °C – P < 0.04); after 45 minutes (IP = 24.5 ± 2.3 °C and IP =
22.1 ± 3.5 °C – P < 0.05); after 75 minutes (IP = 26.4 ± 2.2 °C and CWI = 24 ± 2.7 °C – P < 0.02). Conclusion:
After the 30-minute application, both IP and CWI produced the appropriate temperature; however the ap-
plication of CWI produced the lowest temperature during rewarming.
[P]

Keywords: Cryotherapy. Physiotherapy modalities. Ankle. Athletes.

[B]

Resumo
Introdução: A crioterapia é frequentemente utilizado para reabilitação de atletas lesionados. Objetivo:
Objetivou-se comparar a eficácia da aplicação do pacote de gelo convencional (PG) em relação à crioimer-
são (CI) na diminuição da temperatura superficial da pele do tornozelo de atletas. Materiais e métodos:
A amostra foi composta por 13 atletas (sete do gênero feminino e seis do masculino), idade de 19,53 (± 2,9) anos.
O PG e a CI foram aplicados sobre o ligamento talofibular anterior do tornozelo dominante, por 30 minutos.
A temperatura superficial da pele foi verificada pré-aplicação e durante a crioterapia (10, 15, 20, 25 e 30 mi-
nutos) e até duas horas de reaquecimento, com termômetro digital infravermelho. Para as coletas no período
de reaquecimento, os atletas permaneceram em repouso, com temperatura verificada a cada 1 minuto, até 10
minutos, a cada 5 minutos, até uma hora, e a cada 15 minutos, até duas horas. Resultados: As duas formas de
aplicação de crioterapia apresentaram efetividade para a redução da temperatura superficial da pele, após os
30 minutos de procedimento. Na comparação entre os grupos, houve diferença significativa nas temperaturas:
pré-aplicação (PG = 29,8 ± 2,4 °C e CI = 27,5 ± 3 °C – P < 0,05); e ao fim de 30 minutos (PG = 5 ± 2,4 °C e CI = 7,8 ±
3 °C – P < 0,01). Para o reaquecimento, encontrou-se: após 15 minutos (PG = 20,8 ± 3,3 °C e CI = 18,2 ± 2,7 °C –
P < 0,04); após 45 minutos (PG = 24,5 ± 2,3 °C e CI = 22,1 ± 3,5°C – P < 0,05); após 75 minutos (PG = 26,4 ±
2,2 °C e CI = 24 ± 2,7 °C – P < 0,02). Conclusão: Concluiu-se que, ao final dos 30 minutos de aplicação, PG e CI
alcançaram a temperatura adequada para os benefícios da crioterapia, porém a crioimersão obteve menor
temperatura no período de reaquecimento. [K]

Palavras-chave: Crioterapia. Modalidades de fisioterapia. Tornozelo. Atletas.

Introduction superficial tissues, accompanied by a reduction

Cryotherapy has been used in elite and amateur
athletes to treat acute musculoskeletal injuries and
to assist an athlete's recovery after strenuous exercise.
The pathophysiology of soft tissue injuries is char-
acterized by high cellular metabolism, hemorrhage,
hyperemia, edema and local inflammation (1). It also
causes muscle dysfunctions such as myofibril dis-
turbance, rupture of mitochondria and sarcoplasmic
reticulum, interruption of sarcolemma continuity,
cellular self-digestion and cell death (2). Additionally,
the response to the primary injury can lead to sec-
ondary injury, which occurs from both enzymatic and
hypoxic mechanisms in the cells on the periphery of
the primary injury (3).
Physiological and clinical evidence suggest
that the primary response of the body to cold ap-
plication is the reduction in temperature of the
in the speed of nerve conduction, muscle cramp,
muscle activity levels of metabolic enzymes, inhi-
bition of nociceptors (4) and reduced local blood
flow (5). Considering the pathophysiology of the
soft tissue injuries, it was found that cryotherapy
reduces the inflammatory reaction after trauma
(6), slows the formation of edema (7), reduces the
local metabolism and minimizes the degree of tis-
sue injury (8), the secondary hypoxia injury (9)
and pain (4, 10).
After 10 minutes of cold application, the surface
temperature increases probably due to removal of
the ice pack, the skin exposure to room temperature
and to hemodynamic changes between the cooled
tissue and adjacent tissues with higher temperature,
which results in rewarming. It is estimated that the
rewarming period lasts at least two hours after using
cryotherapy (11-13).

Fisioter Mov. 2015 Jan/Mar;28(1):23-30


Several procedures are described for the applica-
tion of cryotherapy (gels, sprays, ice packs, immer-
sion, etc). However, in clinics and hospitals and in
sports medicine, ice packs are the most commonly
used treatment (14). Previous studies have proved
the efficacy in the reduction of tissue temperature
(15-18). For cooling depth, it was demonstrated that
the ice pack applied to the ankle joint for 20 minutes
has caused physiological changes in at least 1 cm (14).
Cryotherapy has been mainly used in athletes after
sports practice to reduce the damage caused by stren-
uous exercise. Gregson et al. (19) compared the im-
mersion in cold water in two different temperatures
(8 °C and 22 °C) and found that both temperatures
produced lower rectal and skin surface temperature.
These temperatures also reduced the arterial blood
flow in 30% immediately after cold water immer-
sion, and in 40%, 30 minutes after the procedure is
complete, with more significant reductions in im-
mersion at 8 °C. Systematic review studies observed
that the most frequently used temperature of water
immersion ranged from 10 °C and 15 °C, in 5 and 24
minutes, respectively (20, 21). It is believed that the
cold water immersion is an adequate treatment for
acute ankle sprain as it is able to cover the largest
area of the distal end of the lower limb.
Given the widespread use of ice pack and cold wa-
ter immersion in sports, further studies are necessary
to compare these two types of methods and point out
possible differences. Thus, the objective of this study
was to analyze the effect of conventional ice pack
compared to cold water immersion on decreasing
the skin superficial temperature in athletes, as well
as on the period of rewarming and systemic effect.
Materials and methods
This was a randomized cross-over study. Thirteen
athletes (seven women and six men), mean age 19.53
(± 2.9) years, BMI between18.5 to 25 (normal index
according to the World Health Organization), without
injuries or complaints in the ankle of the dominant
leg in the last six months participated in the study.
Participants were excluded if they had above or below
the average BMI normal value (17).
This study was approved by the Research Ethics
Committee-UEL (case No 222/08). All participants
were informed about the study and agreed to partici-
pate by providing their free and informed consent.
Effect of cryotherapy on the ankle temperature in athletes
25
The athletes underwent cryotherapy with the ap-
plication of a 300 g ice pack (IP) (17) for 30 minutes
over the anterior talofibular ligament (ATFL) of the
dominant lower limb (14, 22, 23). Additionally, the
participants immersed their ankle in a recipient with
water level at 10 cm above the lateral malleolus, with
the temperature ranging from 0 to 5 °C during the
same time period (24). Cryotherapy procedures were
developed in two sessions, with a 72-hour lapse be-
tween them. There was a drawing to determine which
procedure would be used on the first day (ice pack or
the cold water immersion), therefore, the sequence
of applications was randomized.
For data collection, each subject was instructed to
sit for 20 minutes in a room with constant tempera-
ture of 22 °C (± 1 °C), to stabilize skin temperature,
metabolism and blood flow. Meanwhile, questions
were asked to obtain anthropometric and personal
data (name, age, weight, height, BMI, training time,
weekly workouts, spots modality, dominance, previ-
ous injuries and the absence of injury in the ankle of
the dominant limb).
At the end of the initial rest time, the skin tempera-
ture in the ATFL of the dominant ankle was measured.
CWI was applied over the anteromomedial aspect of
the ankle lateral to medial malleolus (1 cm distant)
and the skin temperature was recorded. The tempera-
ture was measured using the Mult Temp IncotermTM
portable digital infrared thermometer (Indústria de
Termômetros). The temperature was measured prior
to treatment, and with 10, 15, 20, 25 and 30-min-
ute procedure (15). After the application ended, the
athlete remained at rest for two hours, in supine
position; the temperature was checked at the point
marked on the ligament region every minute, up to 10
minutes and every five minutes up to an hour. After
the one-hour rest, the temperature was measured
every 15 minutes for two hours. The same procedure
was performed on the second day of collection.
Simultaneously with the use of cryotherapy, the
body pre-application temperature was recorded 15
minutes and 30 minutes, using a mercury thermom-
eter under the armpit of the dominant upper limb to
evaluate the systemic effect of the cryotherapy (25).
The data were statistically analyzed and expressed
in tables. The Shapiro-Wilk test was applied before
the comparative analysis of the group to determine
the normality of the sample. For the comparison be-
tween the methods and the data collection time, the
paired Student's t-test was employed followed by
Fisioter Mov. 2015 Jan/Mar;28(1):23-30
 Santos VBC, Cardoso CS, Figueiredo CP, Macedo CSG.
26
two-way analysis of variance (ANOVA) for repeated
measures and Bonferroni post hoc. The level of sig-
nificance was set at 5% (p ≤ 0.05). Statistical analyses
were performed using Statistical Package for Social
Sciences Version 20 (SPSS Inc., Chicago, Il, USA).
Results
The mean age of participants was 19.53 (± 2.9)
years and the anthropometric characteristics pre-
sented weight of 67.23 (± 10.38) kg, height of 170.53
(± 11.67) cm and BMI of 23.13 (± 2.92) Kg.m-2.
Among these athletes, 53.85% practiced athletics
and 46.15% futsal. The training time was on average
6.65 (3.63 ±) years, 5.76 (± 1.09) times a week, 14.92
(± 2.28) hours per week. There was a 92.30% pre-
dominance of right-handed dominance. For the previ-
ous injury, 76.93% of the athletes showed an injured
ankle for more than a year, among these, 72.73% were
sprains, followed by tendinitis of the Achilles tendon,
fibula fracture and a fibula fracture associated with
ankle sprain, both with 9.09%. Physiotherapy was
performed in 72.73% of injuries, followed by cryo-
therapy with 18.18%.
The mean temperature during the application
of cryotherapy (IP and CWI) pre, 10, 15, 20, 25
and 30 minutes were respectively: 29.80 °C (±
2.47), 8.05 °C (± 3.01), 7.29 °C (± 3.25), 6.51 °C (±
3.17), 5.75 °C (± 4.07) and 5.06 °C (± 2.44) in the
40
30
Temperature (˚C)
20
10
0
Pré 10’
Ice pack
Figure 1 - Mean and standard deviation of the skin temperature over the anterior talofibular ligament of the ankle measured
during the application of both cryotherapy methods
Note: * P ≤ 0.05.
Fisioter Mov. 2015 Jan/Mar;28(1):23-30
ice pack group and 27.55 °C (± 3.06), 8.70 °C (± 0.87),
7.33 °C (± 1.10), 7.06 °C (± 1.69), 7.70 °C (± 2.82)
and 7.83 ºC (± 3.09) in the cold water immersion
group. There was a significant different in compar-
ing before and immediately after applications using
IP (P < 0.0001) and CWI (P < 0.0001), demonstrat-
ing the effectiveness of both types of cryotherapy.
However, significant differences were only found
between the groups for the pre-cooling (P < 0.05)
and the 30-minute application values (P < 0.01),
the latter with lower temperature value for the IP
group (Figure 1).
The values of the skin surface temperature after
the application (during rewarming time) of the two
types of cryotherapy presented significant differences
between methods at 15 minutes (IP = 20.8 ± 3.3 °C
and CWI = 18.2 ± 2.7 °C – P ≤ 0.04), 45 minutes (IP =
24.5 ± 2.3 °C and CWI = 22.1 ± 3.5 °C – P ≤ 0.05) and
after 75 minutes (IP = 26.4 ± 2.2 °C and CWI = 24 ±
2.7 °C – P ≤ 0.02) of application. Figure 2 shows the
behavior of the skin superficial temperature dur-
ing rewarming.
For the systemic temperature, significant differ-
ence was observed between periods or cryotherapy
modalities. The skin temperature measured before
the application of ice pack was 36.52 °C (± 0.37),
at 15 minutes, 36.50 °C (± 0.47) and at 30 minutes,
36.48 °C (± 0.50). Temperatures recorded after the
application of CWI were 36.47 °C (± 0.37), 36.50 °C
(± 0.34) and 36.51 °C (± 0.43), respectively.
Cooling the skin surface
15’ 20’ 25’ 30’
Time (minutes)
Cold water immersion

40 Cooling the skin surface
30
Temperature (˚C)
20
10
0
Pós 15’ 30’
Ice pack
Figure 2 - Mean and standard deviation of the skin temperature over the anterior talofibular ligament of the ankle measured
after the application of cryotherapy
Note: *P ≤ 0.05.
Discussion
The results of this study suggest both types of ap-
plication, icepack and cold water immersion, were
effective in reducing the skin surface temperature of
the ankle in athletes, considering that temperatures
below 10 °C after 30 minutes of application were
observed, which confirms the physiological effects
and indication for the use of this therapeutic mo-
dality. Leventhal et al. (15) reported that when ice
applications are used directly on the skin, the tissue
cooling is generally superficial and can range from 1 °C to
10 °C, where the effects of cryotherapy are beneficial.
Previous studies have established that the analgesic
effects begin after the skin temperature reaches ap-
proximately 14.4 °C (26), or when it is lower than 10 °C
(10) by reducing the number and speed of painful
impulses sent to the brain by the peripheral nerves (4,
15). The local blood flow decreases when the tissue
temperature reaches 13.8 °C (26) to help control the
formation of edemas, blood leak by injured vessels
(14) and tissue hemorrhage (2). A reduction of the
metabolic enzyme activity in 50% occurs in tempera-
tures between 10 °C and 11 °C (27). When associated
with the decrease in the number of leukocytes in the
injured site, this reduction can reach over 50% (8).
Even with frequent use of cryotherapy in sports
injuries, however, there are still questions with re-
gard to the differences in the cooling capacity of
Effect of cryotherapy on the ankle temperature in athletes
27
45’ 60’ 75’ 90’ 105’ 120’
Time (minutes)
Cold water immersion
the different methods of application, and a direct
comparison between these methods becomes nec-
essary. A few available studies report comparisons
of the same protocol and many studies do not con-
trol the heterogeneous characteristics of individuals
(age, thickness of skin tissue) as well as the physical
characteristics of the cold modality applied (size/
area, weight) (16).Therefore, the present study was
developed with the use of 300 g ice pack (17) and
CWI with water level at 10 cm above the lateral mal-
leolus in all athletes with normal BMI in an attempt
to reduce the interference of adipose tissue (28)
in cooling and rewarming the superficial skin. It is
known that individuals with thicker skin require a
longer period of cold application to produce similar
temperature changes (17, 29-31).
Thus, it is important to know the cooling effects
provided by each modality of ice application used for
the optimization of clinical response and appropri-
ate use (32); in their study, Costello et al. (33) sug-
gested that further research is necessary for structur-
ing guidelines and specific protocols. Therefore, this
study used an infrared thermometer to compare the
effects of IP and CWI application on skin surface tem-
perature because it is safer and noninvasive (29). The
results showed that both modalities presented sig-
nificant reductions in skin surface temperature at the
end of 30-minute application; however, the ice pack
has produced higher tissue cooling when compared
Fisioter Mov. 2015 Jan/Mar;28(1):23-30
 Santos VBC, Cardoso CS, Figueiredo CP, Macedo CSG.
28
to cold water immersion (P ≤ 0.01), which agrees
with the study of Kennet et al. (12). Additionally,
Tomchuk et al. (34) analyzed the superficial and
deep temperature during and after the ice pack ap-
plication and concluded that immediately after the
removal, the skin surface starts to rewarm, while the
intramuscular temperature continues to reduce for
approximately 5 to 10 minutes.
Our study has also analyzed the time of rewarm-
ing and observed lower skin surface temperatures
when CWI was applied after 15, 45 and 75 minutes
of removal. Myrer et al. (35) compared the superficial
and deep cooling and rewarming effects caused by
the IP and CWI in whirlpool, and in agreement with
our findings, they observed a significant reduction in
skin surface temperature in the group submitted to
IP. However, the cold immersion treatment reached
the deeper tissues, maintaining the intramuscular
cooling even after the removal, which did not occur
in the group submitted to the ice pack. Moreover,
Herrera et al. (16) compared the three modalities
(cold water immersion ice pack and massage with
ice) and concluded that these methods caused the
reduction in skin temperature and in the nerve con-
duction speed, nonetheless, CWI presented better
results and was considered the most effective method
for local analgesia.
No significant differences were found in systemic
temperature values of the individuals studied, which
shows that the cooling of the distal region of the lower
limb did not produce effects throughout the body,
only locally. Several studies have observed reduc-
tions in the systemic temperature after cryotherapy,
however, in these studies a greater body area was
exposed to cold (19, 36), which may explain the dif-
ferent results found.
Conclusion
It was observed that at the end of 30 minutes of ice
pack and cold water immersion application, the skin
temperature reaches appropriate values to promote
analgesia, control of the inflammatory process, de-
creased metabolism and nerve conduction, according
to the literature. Additionally, the ice pack application
presented lower values of skin surface temperature in
the ankle region at the end of 30 – minute application.
Fisioter Mov. 2015 Jan/Mar;28(1):23-30
However, during the 2 hour rewarming period,
cold water immersion was able to produce lower tem-
peratures, which should be considered in the acute
phase of ankle injuries in athletes.
References
1. Brancaccio N, Klein AA, Böettche GA, Colla PHS, Mach-
ado DM, Moser GR, et al. Análise de lesão muscular
em ratos treinados e sedentários submetidos a cri-
oterapia. Fisioter Mov. 2005;18(1):59-65.
2. Matheus JPC, Milani JGPO, Gomide LB, Volpon JB, Shi-
mano AC. Análise biomecânica dos efeitos da criote-
rapia no tratamento da lesão muscular aguda. Rev
Bras Med Esporte. 2008;14(4):373-5. doi: 10.1590/
S1517-86922008000400010.
3. Oliveira NML, Gava AD, Salvini TF. O efeito da cri-
oterapia e compressão intermitente no músculo
lesado de ratos: uma análise morfométrica. Rev
Bras Fisioter. 2007;11(5):403-09. doi: 10.1590/
S1413-35552007000500012.
4. Algafly AA, George KP. The effect of cryotherapy on
nerve conduction velocity, pain threshold and pain
tolerance. Br J Sports Med. 2007;41(6):365-69.
5. Manso JMG, Matoso DR, Ruiz DR, Saa SSY, Calderón
J. Effect of cold-water immersion on skeletal muscle
contractile properties in soccer players. Am J Phys
Med Rehabil. 2011;90(5):356-63. doi: 10.1097/
PHM.0b013e31820ff352.
6. Cameron MH, editor. Physical agents in rehabilitation:
from research to practice. Philadelphia: WB Saunders;
1999.
7. Deal DN, Tipton J, Rosencrance E, Curl WW, Smith
TL. Ice reduces edema. A study of microvascular
permeability in rats. J Bone Joint Surg Am. 2002;
84-A(9):1573-8.
8. Capps SG, Mayberry B. Cryotherapy and intermittent
pneumatic compression for soft tissue trauma. IJATT.
2009;14(1):2-4.
9. Merrick MA, Rankin JM, Andres FA, Hinman CL. A pre-
liminary examination of cryotherapy and second-
ary injury in skeletal muscle. Med Sci Sports Exerc.
1999;31(11):1516-21.

10. Singh H, Osbahr DC, Holovacs TF, Cawley PW, Speer KP.
The efficacy of continuous cryotherapy on the post-
operative shoulder: a prospective, randomized inves-
tigation. J Shoulder Elbow Surg. 2001;10(6):522-5.
11. Chesterton LS, Foster NE, Ross L. Skin temperature
response to cryotherapy. Arch Phys Med Rehabil.
2002;83(4):543-9.
12. Kennet J, Hardaker N, Hobbs S, Selfe J. Cooling effi-
ciency of 4 common cryotherapeutic agents. J Athl
Train. 2007;42(3):343-8.
13. Pastre CM, Bastos FN, Netto Junior JN, Vanderlei
LCM, Hoshi RA. Métodos de recuperação pós-exercí-
cio: uma revisão sistemática. Rev Bras Med Esporte.
2009;15(2):138-44.
14. Enwemeka CS, Allen C, Avila P, Bina J, Konrade J,
Munns S. Soft tissue thermodynamics before, dur-
ing, and after cold pack therapy. Med Sci Sports Exerc.
2002;34(1):45-50.
15. Leventhal LC, Bianchi RC, Oliveira SMJV. Ensaio
clínico comparando três modalidades de criote-
rapia em mulheres não grávidas. Rev Esc Enferm
USP. 2010;44(2):339-45. doi: 10.1590/S0080-
62342010000200014.
16. Herrera E, Sandoval MC, Camargo DM, Salvini TF.
Motor and sensory nerve conduction are affected
differently by ice pack, ice massage, and cold water
immersion. Phys Ther. 2010;90(4):581-91.
17. Kanlayanaphotporn R, Janwantanakul P. Comparison
of skin surface temperature during the application of
various cryotherapy modalities. Arch Phys Med Re-
habil. 2005;86(7):1411-5.
18. Fang L, Hung CH, Wu SL, Fang SH, Stocker J. The ef-
fects of cryotherapy in relieving postarthroscopy
pain. J Clin Nurs. 2001;21(5-6):636-43.
19. Gregson W, Black MA, Jones H, Milson J, Morton
J, Dawson B, et al. Influence of cold water im-
mersion on limb and cutaneous blood flow at
rest. Am J Sports Med. 2011;39(6):1316-23. doi:
10.1177/0363546510395497.
20. Bleakley C, McDonough S, Gardner E, Baxter GD,
Hopkins JT, Davison GW. Cold-water immersion
(cryotherapy) for preventing and treating muscle
soreness after exercise. Cochrane Database Syst Rev.
2012;2:CD008262. doi: 10.1002/14651858.
Effect of cryotherapy on the ankle temperature in athletes
29
21. Bleakley CM, Costello JT, Glasgow PD. Should athletes
return to sport after applying ice? A systematic re-
view of the effect of local cooling on functional per-
formance. Sports Med. 2012;42(1):69-87.
22. Patterson SM, Udermann BE, Doberstein ST, Reineke
DM. The effects of cold whirlpool on power, speed,
agility, and range of motion. J Sports Sci Med. 2008;
7(3):387-94.
23. Surenzok O, Aytar A, Tüzün EH, Akman MN. Cryoter-
apy impairs knee joint position sense and balance.
Isokinet Exerc Sci. 2008;16(1):69-73.
24. Evans TA, Ingersoll C, Knight KL, Worrell T. Agility
following the application of cold therapy. J Athl Train.
1995;30(3):231-4.
25. Khanmohammadi R, Someh M, Ghafarinejad F. The ef-
fect of cryotherapy on the normal ankle joint position
sense. Asian J Sports Med. 2011;2(2):91-8.
26. Starkey C. Recursos terapêuticos em fisioterapia. São
Paulo: Manole; 2001.
27. Zachariassen KE. Hypothermia and cellular physiol-
ogy. Arctic Med Res. 1991;50(Suppl 6):13-7.
28. Bleakley CM, Glasgow P, Webb MJ. Cooling an acute
muscle injury: can basic scientific theory translate into
the clinical setting? Br J Sports Med. 2012;46(4):296-8.
29. Jutte LS, Merrick MA, Ingersoll CD, Edwards JE. The
relationship between intramuscular temperature,
skin temperature, and adipose thickness during
cryotherapy and rewarming. Arch Phys Med Rehabil.
2001;82(6):845-50.
30. Otte JW, Merrick MA, Ingersoll CD, Cordova M. Sub-
cutaneous adipose tissue thickness alters cooling
time during cryotherapy. Arch Phys Med Rehabil.
2002;83(11):1501-5.
31. Bleakley CM, McDonough S, MacAuley D. The use of
ice in the treatment of acute soft-tissue injury : a sys-
tematic review of randomized controlled trials. Am J
Sports Med. 2004;32(1):251-61.
32. Carvalho AR, Medeiros DL, Souza FT, Paula GF, Barbosa
PM,Vasconcellos PRO, et al. Variação de temperatura
do músculo quadríceps femoral exposto a duas mo-
dalidades de crioterapia por meio de termografia. Rev
Bras Med Esporte. 2012;18(2):109-11.
Fisioter Mov. 2015 Jan/Mar;28(1):23-30
 Santos VBC, Cardoso CS, Figueiredo CP, Macedo CSG.
30

33. Costello JT, McInerney CD, Bleakley CM, Selfe J, Don-
nelly AE. The use of thermal imaging in assessing skin
temperature following cryotherapy: a review. J Therm
Biol. 2012;37(2):103-10.
34. Tomchuk D, Rubley MD, Holcomb WR, Guadagnoli M,
Tarno JN. The magnitude of tissue cooling during cryo-
therapy with varied types of compression. J Athl Train.
2010;45(3):230-7. doi: 10.4085/1062-6050-45.3.230.
36. Savalli L, Olave P, Sendin MIH, Laboute E, Trouvé
P, Puig PL. Cryothérapie corps entier à –110 °C.
Mesure des températures cutanées et centrale chez
le sportif. Sci Sports. 2006;21(1):36-8. doi: 10.1016/
j.scispo.2006.01.005.
Received: 12/07/2013
Recebido: 07/12/2013

35. Myrer W, Meason G, Fellingham GW. Temperature Approved: 07/15/2014

changes in the human leg during and after two meth- Aprovado: 05/07/2014
ods of cryotherapy. J Athl Train. 1998;33(1):25-9.

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